Melbourne School of Population and Global Health - Research Publications
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ItemAntenatal mood and fetal attachment after assisted conception(Elsevier, 2007)Objective: Australian women conceiving with ART are at fourfold risk of admission to early parenting treatment programs compared to those conceiving spontaneously. The study aimed to identify prevalence and determinants of antenatal mood disturbance and other risks for early parenting difficulties after assisted conception. Design: A prospective longitudinal investigation from conception to 18 months postpartum using telephone interviews and self-report questionnaires. Setting: Melbourne IVF and Royal Women’s Hospital Reproductive Services, Victoria, Australia. Patient(s): A consecutive cohort of English-speaking women with ultrasound-confirmed ART -conceived pregnancies. Main outcome measure(s): Standardized psychometric measures of mood, quality of marital relationship, mother to fetus emotional attachment, and personality. Intervention(s): None Result(s): Of the 288 women with a confirmed pregnancy, 239 were contactable, 183 (77%) recruited and 95% completed both early and late pregnancy assessments. Participants were socioeconomically advantaged, had very good pregnancy health, exceptional marital relationships, normal personality styles and intense affectionate attachment to the fetus. Very few (< 5%) had clinically significant mood disturbance in late pregnancy. Conclusions: There were low rates of antenatal mood disturbance and other risk factors for postpartum depression. Pregnancy and motherhood might be idealised after ART conception and preparation for the realities of infant care might then be insufficient.
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ItemAssisted conception is a risk factor for postnatal mood disturbance and early parenting difficulties(Elsevier, 2005)Objective: To investigate whether assisted conception is associated with an increased risk of admission to a residential early parenting program for treatment of maternal mood disorder or infant feeding or sleeping disorders in the postpartum year. Design: Systematic audit of consecutive medical records. Setting: Masada Private Hospital Mother Baby Unit (MPHMBU), Melbourne, Australia Patients: Medical records of all mother-infant dyads admitted to MPHMBU between July 2000 and August 2002. Main outcome measures: Modes of conception and delivery of index infant, maternal and infant age on admission, multiplicity of birth, infant birthweight and Edinburgh Postnatal Depression Scale scores. Results: A total of 745 records were audited and mode of conception was recorded in 526 (70.6%) of records. Overall 6% (45 / 745) of the admitted infants had been conceived through ART compared to 1.52% in the general population (RR 4.0, 95% CI 3.0 - 5.4). Mothers who had conceived with ART were older and more likely to have had caesarean and multiple births than those who conceived spontaneously. Conclusions: Assisted conception appears to be associated with a significantly increased rate of early parenting difficulties. Women who experience assisted conception may require additional support after their babies are born.
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ItemTreatment of maternal mood disorder and infant behaviour disturbance in an Australian private mothercraft unit: a follow-up study( 2003)Australia has a system of residential parentcraft services which offer brief admissions to mothers experiencing difficulties with infant care and postnatal mood disturbance. Most of these are state-funded public access services. In 1996 a comparable but differentiated service was opened in the private sector. Masada Private Hospital Mother Baby Unit accommodates five mother-infant pairs who are admitted to a five night structured residential program. Care is provided by a multidisciplinary team comprising a paediatrician, general practitioner, clinical psychologist and specialist nurses. Complex maternal mood disorders as measured on standardised psychometric instruments include depression, anxiety and severe occupational fatigue. Their babies are unsettled, cry for prolonged periods, wake frequently at night and do not sleep well during the day. Many have feeding difficulties. The treatment program comprises both individualised training in infant care and settling strategies and psycho-educational groups offered in a supportive non-judgemental setting. One month post-discharge maternal mood is significantly improved and infant behaviour more manageable compared with functioning on admission.
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ItemTemperament and behaviour of infants aged 4-12 months on admission to a private mother-baby unit and at one- and six-month follow-up( 2004)While infant behaviour is influenced by maternal care, infant crying and dysregulated sleep can reciprocally affect maternal mood. The temperament and behaviour of two 4 – 12-months-old infant cohorts admitted with their mothers to a residential parenting program were examined using behaviour charts and the Short Infant Temperament Questionnaire (SITQ). One group was re-assessed one and six months later. Infant temperament was significantly more difficult than population norms and most had dysregulated sleep. One month after treatment, total infant crying and fussing, frequency of night-time waking,and sleep and feeding dysregulation were significantly (p5<.001) reduced, with change sustained at six months. Easy-Difficult scores (SITQ) were stable and significantly worse than population norms. The contribution of a ‘‘difficult’’ infant temperament to maternal mood disorder warrants further investigation.
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ItemEarly parenting difficulties: implications for health services policy( 2005)Australia’s residential early parenting centres are unique internationally and provide a highly valued service to parents and their very young children. Clinical practice in these services has been based on extensive experience, but now needs to be derived from an evidence base. In response to this need, Tweddle Child and Family Health Service (TCFHS) in Melbourne - a public access early parenting service - commissioned a review of literature relating to its practice and a prospective longitudinal survey of a consecutive group of mothers admitted with infants aged up to one year. This article summarises the main findings of both the literature review and the survey. Australia’s public access residential early parenting centres are a unique national resource and were established initially for the care of abandoned, relinquished or mistreated young children. Over time their purpose and function has altered to reflect social change associated with reduction in relinquishment of children for adoption, and policies that have sought to minimise removal of children from parental care. Now they focus on assisting parents to improve caretaking capacity. There are no equivalent services in any other country in the world. In general, services for parents experiencing difficulty caring for their infants in industrialised countries are based in primary health care of outreach home visiting services. Consumer satisfaction surveys indicate that parents value early parenting services highly, but as yet there is a limited evidence base to their clinical practice.